Provider Demographics
NPI:1982701520
Name:SERLE, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:SERLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 DEERWOOD PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4849
Mailing Address - Country:US
Mailing Address - Phone:904-814-8417
Mailing Address - Fax:904-385-3908
Practice Address - Street 1:10752 DEERWOOD PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4849
Practice Address - Country:US
Practice Address - Phone:904-814-8417
Practice Address - Fax:904-385-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9887111NN0400X
NJMC005560NJ111NI0013X
FL832246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other